Preventing and Caring for Pressure Sores (Bedsores) at Home

Pressure sores, also called bedsores or pressure ulcers, are areas of damaged skin caused by staying in one position for too long. Constant pressure cuts off blood flow to the skin, and the skin starts to break down. They form fastest over bony areas where there is little padding between bone and skin.

The most common spots are the tailbone and lower back, hips, heels, ankles, elbows, shoulders, the back of the head, and the ears. For someone who sits in a wheelchair most of the day, the tailbone and buttocks are the biggest concern.

Some people are much more likely to get them. Watch closely if your loved one:

Prevention is far easier than treatment, and most bedsores can be avoided. The goal is simple: take pressure off the skin, keep it healthy, and catch problems early. Four habits do most of the work.

1. Reposition on a schedule. If your loved one is in bed, help them change position at least every 1 to 2 hours. If they sit in a wheelchair or chair, shift their weight every 15 to 20 minutes, or help them stand or lean if they can. Use pillows to keep knees and ankles from pressing together, and place a pillow under the calves so the heels float off the bed. Do not drag someone across the sheets, because rubbing damages skin. Lift, or use a draw sheet.

2. Check the skin every day. Once a day, look over the whole body, especially the bony areas listed above. Press gently on any red spot. Healthy skin turns white and then pink again. If the redness stays and does not fade, that is an early warning sign. On darker skin, redness can be harder to see, so also feel for areas that are warmer, cooler, firmer, or more tender than the skin around them.

3. Keep skin clean and dry. Wash with mild soap and warm water, pat dry gently, and moisturize dry skin. Change wet or soiled clothing and bedding quickly, since moisture from sweat or incontinence breaks skin down fast. A barrier cream can protect skin in the diaper area. Avoid harsh scrubbing.

4. Support good nutrition and hydration. Skin needs protein, calories, and water to stay strong and to heal. Offer balanced meals with enough protein (such as eggs, beans, chicken, fish, or dairy) and encourage water throughout the day unless a doctor has limited fluids.

The right support surface spreads weight out so no single spot takes all the pressure. You do not need the most expensive product, but you do need the right kind.

For the bed, a foam, gel, or air mattress or overlay helps more than a standard mattress. For a wheelchair or regular chair, use a foam or gel seat cushion made for pressure relief.

One important warning: skip donut-shaped or ring cushions. They actually cut off blood flow around the edge and can cause a sore instead of preventing one. Sheepskin pads and pillows placed between the knees and under the heels are simple, low-cost helpers.

If your loved one qualifies for Medicare home health, ask the nurse or doctor whether a pressure-relieving mattress or cushion can be ordered as durable medical equipment.

Pressure sores get worse in steps, or stages. Knowing them helps you act early, when healing is easiest. The National Pressure Injury Advisory Panel describes four stages plus a category that cannot be staged:

Once a sore breaks the skin (Stage 2 or worse), it usually needs more than a bandage. It needs professional cleaning, the right dressings, and regular checks to make sure it is healing and not getting infected. This is exactly the kind of skilled nursing care Medicare home health is designed to cover.

If your loved one qualifies, a Medicare-certified home health agency sends a nurse to the home to assess and treat the wound, teach you how to change dressings, provide wound supplies, and report progress to the doctor. For people who have trouble leaving home, this is often the most practical way to get expert wound care.

To qualify for Medicare home health, generally all of these must be true: a doctor has certified the need with a plan of care; the patient is homebound (leaving home takes a major effort or is not recommended, though short trips for medical care, worship, or special events are still allowed); the care needed is skilled and part-time or intermittent, not around-the-clock; and the care is provided by a Medicare-certified home health agency.

When you qualify, you pay nothing for covered home health visits, including skilled nursing wound care. There are no copays or deductibles for the covered visits. In Southern California, many Medicare-certified agencies serve Los Angeles, Orange, Riverside, San Bernardino, and San Diego counties, and many have staff who speak Spanish and other languages. Ask the discharge planner at the hospital, or your loved one's doctor, for a referral.

Small red areas that fade can often be handled at home with repositioning and skin care. But some signs mean you should call the doctor or the home health nurse the same day, or seek emergency care.

Call the doctor or nurse promptly if you see redness that does not fade after repositioning, any break in the skin, a sore that is getting bigger or deeper or more painful, drainage or pus or a bad smell, or skin around the wound that is warm, swollen, or increasingly red.

Call 911 or go to the emergency room if there are signs the infection is spreading through the body, such as fever or chills, confusion or new drowsiness, a fast heartbeat, or a wound that exposes muscle or bone. Infected pressure sores can become life-threatening, so when in doubt, get help quickly. This article is for general education and is not a substitute for advice from your loved one's doctor or nurse, who can look at the specific wound and guide treatment.